阿托伐他汀联合氯吡格雷对腔隙性脑梗死患者凝血功能、Hcy、hs-CRP水平、动脉粥样硬化斑块及神经功能的影响
Effect of atorvastatin combined with clopidogrel on coagulation function,Hey,hs-CRP levels,atherosclerotic plaque and neurological function in patients with lacunar cerebral infarction
李燕 1王春 1董路晨 1欧伟丽 1耿杰1
作者信息
- 1. 蚌埠医学院第二附属医院全科医学科 安徽 蚌埠 233000
- 折叠
摘要
目的 探讨阿托伐他汀联合氯吡格雷对腔隙性脑梗死(LI)患者凝血功能、同型半胱氨酸(Hcy)、超敏-C反应蛋白(hs-CRP)水平、动脉粥样硬化斑块及神经功能的影响.方法 前瞻性纳入2020年2月至2023年2月蚌埠医学院第二附属医院收治的住院或门诊的LI患者129例,按随机数字表法分为研究1组、研究2组、对照组,每组各43例.3组均给予常规治疗,在此基础上,研究1组方案为阿托伐他汀钙片20 mg/次+硫酸氢氯吡格雷片75 mg/次,研究2组方案为阿托伐他汀钙片10 mg/次+硫酸氢氯吡格雷片75 mg/次,对照组方案为阿托伐他汀钙片10 mg/次+阿司匹林肠溶片100 mg/次,4周为1个疗程,3组均治疗1个疗程.比较3组治疗前、治疗4周后的纤维蛋白原(FIB)水平、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、Hcy水平、hs-CRP水平、颈动脉内膜中层厚度(IMT)与颈动脉粥样硬化斑块数量、斑块面积.采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,记录3组不良反应发生情况.结果 研究1组、研究2组FIB水平均低于对照组,APTT、PT均高于对照组,且研究1组FIB水平低于研究2组,APTT、PT均高于研究2组,差异均有统计学意义(P＜0.05).治疗4周后,研究1组、研究2组血清Hcy、hs-CRP水平均低于对照组,且研究1组血清Hcy、hs-CRP水平均低于研究2组,差异均有统计学意义(P＜0.05).治疗4周后,研究1组、研究2组IMT、斑块数量、斑块面积均低于对照组,且研究1组IMT、斑块数量、斑块面积均低于研究2组,差异均有统计学意义(P＜0.05).治疗4周后,研究1组、研究2组NIHSS评分均低于对照组,差异均有统计学意义(P＜0.05);研究1组与研究2组NIHSS评分比较,差异无统计学意义(P＞0.05).3组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 与阿托伐他汀联合阿司匹林相比,阿托伐他汀联合氯吡格雷能进一步改善LI患者的凝血功能指标以及Hcy、hs-CRP水平,减轻动脉粥样硬化斑块症状,提升神经功能,以阿托伐他汀20 mg/次给药效果最佳.
Abstract
Objective To investigate the effects of atorvastatin combined with clopidogrel on coagulation function,homocysteine(Hcy)and hypersensitive C-reactive protein(hs-CRP)levels,atherosclerotic plaque and neurological function in patients with lacunar infarction(LI).Methods A total of 129 patients with LI who were hospitalized or outpatients in The Second Affiliated Hospital of Bengbu Medical Univer-sity from February 2020 to February 2023 were divided into the study group 1,the study group 2 and the control group according to random number table method,with 43 cases in each group.All the three groups were given conventional treatment.On this basis,the study group 1 was given atorvastatin calcium tablet 20 mg/time combined with Clopidogrel bisulfate tablet 75 mg/time.The regimen of the study group 2 was atorvastatin calcium tablet 10 mg/time combined with Clopidogrel bisulfate tablet 75 mg/time.The control group was atorvastatin calcium tablet 10 mg/time+aspirin enteric-coated tablet 100 mg/time.Four weeks was a course of treatment,and all three groups received 1 course of treatment.The fibrin-ogen(FIB),activated partial thromboplastin time(APTT),prothrombin time(PT),Hcy levels,hs-CRP levels,carotid intimatomedia thick-ness(IMT)and the number and area of carotid atherosclerotic plaques were compared between the three groups before and after 4 weeks of treat-ment.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological impairment,and the adverse reac-tions of the three groups were recorded.Results After 4 weeks of treatment,the FIB of the study group 1 and study group 2 were lower than those of the control group,while APTT and PT were higher than those of the control group,in addition,the FIB of the study group 1 was lower than that of the study group 2,and APTT and PT were higher than those of the study group 2,the differences were statistically significant(P＜0.05).Af-ter 4 weeks of treatment,the levels of serum Hcy,hs-CRP in the study group 1 and study group 2 were lower than those in control group,and those in the study group 1 were lower than those in the study group 2,the differences were statistically significant(P＜0.05).After 4 weeks of treatment,IMT,plaque number and plaque area in the study group 1 and study group 2 were lower than those in the control group,and those in the study group 1 were lower than those in the study group 2,the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the NIHSS score of the study group 1 and study group 2 were lower than that of the control group,the differences were statistically significant(P＜0.05);there was no statistically significant difference in NIHSS scores between the study group 1 and study group 2(P＞0.05).There was no statistically significant difference in the adverse reaction rate of three groups(P＞0.05).Conclusion Compared with atorvastatin combined with aspirin,atorvastatin combined with clopidogrel can further improve the coagulation indexes,Hcy and hs-CRP levels in patients with lacunar cerebral infarction,reduce the symptoms of atherosclerosis plaque,and improve nerve function,and atorvastatin administered 20 mg/time has the best effect.
关键词
脑梗死/阿托伐他汀/氯吡格雷/同型半胱氨酸/超敏-C反应蛋白Key words
Brain infarction/Atorvastatin/Clopidogrel/Homocysteine/Hypersensitive C-reactive protein引用本文复制引用
基金项目
安徽省教育厅自然科学重点研究项目(2022AH051456)
出版年
2024
NETL
NSTL
维普
万方数据